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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 267750002
Report Date: 09/07/2023
Date Signed: 09/08/2023 01:59:44 PM

Document Has Been Signed on 09/08/2023 01:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MAMMOTH INCLUSIVE PRESCHOOLFACILITY NUMBER:
267750002
ADMINISTRATOR:TAMMY NGUYENFACILITY TYPE:
850
ADDRESS:1500 MERIDIAN BLVD.TELEPHONE:
(760) 934-7545
CITY:MAMMOTH LAKESSTATE: CAZIP CODE:
93546
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 2DATE:
09/07/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lisa Glen, ConsultantTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Maddox met with Tammy Nguyen, Director today for the purpose of conducting a Pre-Licensing inspection for a PS component. This PS component is located on the grounds of Mammoth Elementary School in Bldg. J/Classroom #3. The hours of operation will be: Mon through Friday from 8:15 am to 2:45 pm. Applicant is requesting to be licensed for 26 PS children ages 3 to 4. During this inspection, LPA measured 1 classroom (Room #3) and outside play yard designated for PS children.

INDOOR ACTIVITY SPACE:

· The classroom was toured and found to be clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors


· Floors of all rooms have a surface that is safe and clean (wood flooring)
· A comfortable temperature for children shall always be maintained.
· Furniture and equipment are maintained in good condition, free of sharp, lose or pointed parts. There are a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.
· Tables and chairs were present to meet the needs of the children.
· Drinking water is readily available - children bring their own water bottles
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAMMOTH INCLUSIVE PRESCHOOL
FACILITY NUMBER: 267750002
VISIT DATE: 09/07/2023
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· Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were stored and inaccessible to children (stored in high cabinets. Stored in a locked cabinet in the bathroom
· There is/are fully stocked first-aid kit(s) in locations accessible to staff but inaccessible to children:
· The isolation is located in a corner of the classroom.
· LPA observed operable carbon monoxide and smoke detectors and a fully charged fire extinguishers.
· The center has a working telephone
· Sign-in and out procedure -----
· The licensee shall conduct a wellness check to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

OUTDOOR

LPA observed a fenced off area on the Elementary School play yard designated for PS children. Staff will bring drinking water outside for children. The play yard was free of hazards. As a condition of licensure, the areas around and under high climbing equipment shall be cushioned with material that absorbs falls (rubber matting). There are no bodies of water on the premises

RESTROOMS

There is a bathroom located within the classroom that has 1 toilet and 1 sink and a changing table. Toilets, handwashing and bathing facilities were maintained in safe and sanitary operating condition. LPA observed toilet paper, paper towels, and hand soap.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAMMOTH INCLUSIVE PRESCHOOL
FACILITY NUMBER: 267750002
VISIT DATE: 09/07/2023
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Staff bathroom is located in classroom # - there is a staff bathroom located in the entrance area (classroom #3).

SUPERVISION:

Applicant shall ensure no child is left without the supervision of a teacher at any time, Supervision shall include visual observation.

TRANSPORTATION:

Center will not provide transportation

CHILDREN’S RECORDS:


Staff are aware of the required forms for children's records. LPA explained all children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours.
NAPPING

· Mats will be used for napping, LPA observed mats maintained in a safe condition (no exposed foarm).


· Each mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.
· LPA informed Applicant Cots or mats should be wiped with a detergent/disinfectant weekly or when soiled or wet.
· Bedding/Linen will be stored in cubbies.
HEALTH RELATED SERVICES:

Medications shall be kept in a safe place inaccessible to children. A refrigerator shall be used to store any medication that requires refrigeration. Applicant has implemented a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAMMOTH INCLUSIVE PRESCHOOL
FACILITY NUMBER: 267750002
VISIT DATE: 09/07/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

FOOD SERVICES

Children will bring their own lunches, center will supply snacks

· Soaps, detergents, cleaning compounds or similar substances were stored in areas separate from food supplies.


· Food-preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin.
· Trashcans, including moveable bins, shall have a tight fitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.
· There is a refrigerator available to store any medication that requires refrigeration.
POSTINGS:

LPA observed required forms posted on the Parent Board including roster, emergency disaster drill log, and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5

Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

Applicant is reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MAMMOTH INCLUSIVE PRESCHOOL
FACILITY NUMBER: 267750002
VISIT DATE: 09/07/2023
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Measurements taken were as follows:
Room #1 (separated into 3 parts for measuring purposes).
20 X 15.42 = 308/35 = 9
16 X 10.25 = 164/35 = 5
14 X 15.75 = 221/35 = 6
Total for Room #1 = 20

Bathroom:
There's 1 bathroom with 1 toilet, 1 sink, and a changing table.
The Staff bathroom is located in Classroom #1
Outside play space:
45 X X 33 = 1485/75 = 20

Fire Clearance has been received for the requested capacity of 26 children, however, with the Toilet to sink ratio, center will be licensed for 15. Applicant is planning on adding another toilet and sink in the future to accommodate the requested capacity.

Exit Interview conducted, copy of this report left with Tammy Nguyen, Director.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
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